Practice of central nervous system prophylaxis and treatment in acute leukemias in Spain. Prospective registry study.
OBJECTIVE
Central nervous system (CNS) involvement in patients diagnosed with acute leukemias (AL) is an uncommon complication with poor prognosis. The indication and the schedules of prophylaxis and treatment of CNS involvement in AL are not homogenous among countries and within the same country. The aim of this prospective longitudinal study was to analyze and report the practice of CNS prophylaxis and treatment in patients with AL in Spain.


METHODS
Prospective study conducted from June 2005 to June 2006. Adult patients (> or = 18 yr.) diagnosed with AL who received CNS prophylaxis or treatment were consecutively included through online registration.


RESULTS
265 patients from 32 hospitals were included. Mean (standard deviation) age was 44 (16) yr. and 133 (50%) were males. For acute lymphoblastic leukemia patients (n = 158), CNS therapy was given to 12 cases (10 at diagnosis and 2 at relapse) and consisted of triple intrathecal therapy (TIT, methotrexate, cytarabine and hydrocortisone) in 11 and liposomal depot cytarabine in one. CNS prophylaxis (n = 146) consisted of TIT in 135 cases, intrathecal methotrexate in 7, intrathecal cytarabine in 2 and intrathecal liposomal depot cytarabine in 2. No cranial irradiation either for prophylaxis or therapy was given in any case. In acute myeloblastic leukemia patients (n = 107), CNS therapy was administered to 17 cases (9 at diagnosis and 8 at relapse). Intrathecal therapy consisted of TIT in 11, intrathecal liposomal depot cytarabine in 5 and intrathecal cytarabine in one. One patient also received craniospinal irradiation. CNS prophylaxis (n = 90) consisted of TIT in 68 cases and intrathecal methotrexate in 22.


CONCLUSIONS
In Spain, the patterns of CNS prophylaxis and therapy for AL are homogeneous. TIT was the most frequent schedule for CNS prophylaxis and therapy. The lack of use of cranial or craniospinal irradiation and the administration of new drugs (i.e.: liposomal depot cytarabine) for CNS therapy and prophylaxis is of note.
Sancho
Juan-Manuel
JM
Servicio de Hematología Clínica, ICO-Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
Morgades
Mireia
M
Arranz
Reyes
R
Fernández-Abellán
Pascual
P
Deben
Guillermo
G
Alonso
Natalia
N
Blanes
Margarita
M
Rodríguez
María José
MJ
Nicolás
Concepción
C
Sánchez
Eva
E
Fernández de Sevilla
Alberto
A
Conde
Eulogio
E
Ribera
Josep-Maria
JM
D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D016543:Central Nervous System Neoplasms / Q000517:prevention & control*; D003561:Cytarabine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D007278:Injections, Spinal; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008081:Liposomes; D008137:Longitudinal Studies; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011446:Prospective Studies; D012042:Registries; D013030:Spain
D000893:Anti-Inflammatory Agents; D000964:Antimetabolites, Antineoplastic; D008081:Liposomes; D003561:Cytarabine; D006854:Hydrocortisone; D008727:Methotrexate